Identification Risk Factors Of Patent Foramen Ovale Associated Stroke-Construction Of Nomogram

Objective: To identify the risk factors of patent foramen ovale associated stroke(PFO-AS)and construction Nomogram.Methods: In this study,184 patients with PFO were continuously collected and divided into PFO-AS group and control group.By comparing the general information,traditional cerebrovascular disease risk factors,cardiac structure and function,anatomy and hemodynamic characteristics of patent foramen ovale,multivariate Logistic regression was used to explore the high risk factors for PFO-AS,and Nomogram that could individually predict the risk of PFO-AS was established.The differentiation and accuracy of the model were verified.Results:(1)Compared with the general data of the control group,the age of PFO-AS patients was older,and the proportion of male patients was more(P<0.05).The distribution of body mass index was similar between the two groups(P>0.05).Smoking history and hypertension were more likely to be present in PFO-AS patients(P<0.05),but there was no difference in the distribution of drinking history,type 2 diabetes and hyperlipidemia between the two groups(P>0.05).(2)By evaluating the cardiac structure and function of patients in both groups,it was found that compared with the control group,patients with PFO-AS had higher LADI,LVEDd,E/ e ’and LAA-EV(P < 0.05).There was no significant difference in RADI and LVEF between the two groups(P >0.05).(3)By comparing the two groups made anatomy and hemodynamics in patients with found that compared with control group,massive right-to-left Shunt(RLS),resting the LRS incidence was higher(P<0.05).The long tunnel type,Atrial Septal Aneurysm(ASA),EV/CN,high degree of activity of primary septum,Angle between inferior vena cava and oval valve,resting RLS and a large number of RLS were not significantly different between the two groups(P>0.05).(4)The multivariate Logistic regression analysis showed that male,massive RLS and LADI>18 mm/m~2 were the risk factors for the occurrence of PFO-AS(P<0.05).The incidence of PFO-AS in males was 6 times higher than that in females.The probability of PFO-AS in PFO patients with very large number of RLS was 3 times that in PFO patients without very large number of RLS.LADI > 18 mm/m~2 had a threefold risk of PFO-AS compared with the control group.(5)Based on the screened independent risk factors for the occurrence of PFO-AS,this study constructed Nomogram.The Bootstrap method was used for internal verification of Nomogram,and the C-index was 0.799(95%CI:0.739-0.857),indicating that the Nomogram had good discrimination.The ROC curve showed that the modeling group and the verification group were0.793(95%CI: 0.729-0.857)and 0.890(95%CI: 0.862-0.972),respectively.The prediction model of the Nomogram had good prediction accuracy.Calibration curves showed that the modeling group and the verification group were in good agreement with the ideal curves.Conclusions: Male,very large amount of RLS and larger LADI are the high risk factors for PFO-AS.The clinician can predict the risk of PFO-AS based on the Nomogram of the risk of PFO-AS,so as to select the correct treatment and secondary prevention program.